[Medium- and long-term health effects of the L'Aquila earthquake (Central Italy, 2009) and of other earthquakes in high-income Countries: a systematic review]. / Effetti sulla salute a medio e lungo termine del terremoto dell'Aquila del 2009 e di altri terremoti avvenuti in Paesi ad alto reddito: una revisione sistematica della letteratura.

OBJECTIVES: to compare the methodological characteristics of the studies investigating the middle- and long-term health effects of the L'Aquila earthquake with the features of studies conducted after other earthquakes occurred in highincome Countries. DESIGN: a systematic comparison between the studies which evaluated the health effects of the L'Aquila earthquake (Central Italy, 6th April 2009) and those conducted after other earthquakes occurred in comparable settings. METHODS: Medline, Scopus, and 6 sources of grey literature were systematically searched. Inclusion criteria comprised measurement of health outcomes at least one month after the earthquake, investigation of earthquakes occurred in high-income Countries, and presence of at least one temporal or geographical control group. RESULTS: out of 2,976 titles, 13 studies regarding the L'Aquila earthquake and 51 studies concerning other earthquakes were included. The L'Aquila and the Kobe/Hanshin- Awaji (Japan, 17th January 1995) earthquakes were the most investigated. Studies on the L'Aquila earthquake had a median sample size of 1,240 subjects, a median duration of 24 months, and used most frequently a cross sectional design (7/13). Studies on other earthquakes had a median sample size of 320 subjects, a median duration of 15 months, and used most frequently a time series design (19/51). CONCLUSIONS: the L'Aquila studies often focussed on mental health, while the earthquake effects on mortality, cardiovascular outcomes, and health systems were less frequently evaluated. A more intensive use of routine data could benefit future epidemiological surveillance in the aftermath of earthquakes.

Medium- and long-term health effects of earthquakes in high-income countries: a systematic review and meta-analysis.

Background: Accurate monitoring of population health is essential to ensure proper recovery after earthquakes. We aimed to summarize the findings and features of post-earthquake epidemiological studies conducted in high-income countries and to prompt the development of future surveillance plans. Methods: Medline, Scopus and six sources of grey literature were systematically searched. Inclusion criteria were: observational study conducted in high-income countries with at least one comparison group of unexposed participants, and measurement of health outcomes at least 1 month after the earthquake. Results: A total of 52 articles were included, assessing the effects of 13 earthquakes that occurred in eight countries. Most studies: had a time-series (33%) or cross-sectional (29%) design; included temporal comparison groups (63%); used routine data (58%); and focused on patient subgroups rather than the whole population (65%). Individuals exposed to earthquakes had: 2% higher all-cause mortality rates [95% confidence interval (CI), 1% to 3%]; 36% (95% CI, 19% to 57%) and 37% (95% CI, 29% to 46%) greater mortality rates from myocardial infarction and stroke, respectively; and 0.16 higher mean percent points of glycated haemoglobin (95% CI, 0.07% to 0.25% points). There was no evidence of earthquake effects for blood pressure, body mass index or lipid biomarkers. Conclusions: A more regular and coordinated use of large and routinely collected datasets would benefit post-earthquake epidemiological surveillance. Whenever possible, a cohort design with geographical and temporal comparison groups should be used, and both communicable and non-communicable diseases should be assessed. Post-earthquake epidemiological surveillance should also capture the impact of seismic events on the access to and use of health care services.

Physical exercise at high altitude is associated with a testicular dysfunction leading to reduced sperm concentration but healthy sperm quality.

OBJECTIVE: To explore the effect of physical exercise at high altitudes (HA) on male reproductive system. DESIGN: Prospective study. SETTING: Andrology Clinic, University of L'Aquila, Italy. PATIENT(S): Seven male mountaineers involved in an expedition at 5,900 m. INTERVENTION(S): Semen analysis, sperm DNA fragmentation with flow cytometry, and reproductive hormone levels. MAIN OUTCOME MEASURE(S): Hormone levels were evaluated at sea level (SL) at baseline (SL-pre), after 22 days of exercise at HA (intermediate), and after 10 days upon reaching SL (SL-post). Sperm parameters, percentage of sperm with fragmented DNA, and body composition measures were evaluated at SL-pre and at SL-post. RESULT(S): A reduction of sperm concentration, of body mass index (BMI), of waist circumference, and of percentage of body fat was observed at SL-post compared with SL-pre values. Increased levels of FSH and PRL were observed at the intermediate point, and normalized at SL-post, whereas T was higher at SL-post compared with SL-pre levels. CONCLUSION(S): Physical exercise at HA is associated with a testicular dysfunction leading to a reduced sperm concentration probably through an altered spermiation. The improved body composition after physical exercise might explain the higher T levels observed after the expedition.